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Strengths and Limitations in DBT Implementations: A Mid-Stream, Mixed Methods Examination of Successes and Failures
Erin Miga, PhD1,3, Andre Ivanoff, PhD2,4, & Tony DuBose, PsyD2
1Cadence Child and Adolescent Therapy; 2Behavioral Tech, LLC, Seattle, WA; 3Behavioral Research & Therapy Clinics, University of Washington; 4Columbia University
While there is preliminary evidence to support the effectiveness and sustainability of real-world DBT healthcare settings1, few to no studies have conducted a systematic review of DBT implementations on a larger scale. This study assesses a sample of DBT programs nationwide, in order to gain a more systematic understanding of implementation barriers amongst active and inactive programs.
The current study builds on earlier research on the DBT Intensive Training Model 2,3 by including quantitative and qualitative methodologies, including a feedback loop follow-up interview.
The purposes of this study:
INTRODUCTION PHASE 2 RESULTS: INACTIVE VS. ACTIVE TEAMS
METHODS & PROCEDURE Mixed-Methods Approach:
Phase 1 (ACTIVE programs):
DBT Program Elements of Treatment
Questionnaire4 (PETQ: Schmidt, Ivanoff, &
Linehan, 2009)
Follow up telephone interview:
Review and synthesis of current status:
program strengths, weaknesses, and
next steps
Phase 2 (INACTIVE programs):
Barriers to Implementation
Questionnaire5 (BTI: Knox & Dimeff,
2001)
Follow-up consultation as requested
DISCUSSION
Better overall planning for the intensive
(n=11), including selection. level and
commitment of attendees
More clinicians intensively trained (n=8)
Administration commitment at outset to
do DBT to fidelity and devote sufficient
time to strategic planning (n=8)
What one thing would
teams do over?
Top 3 Goals
Achieved
Top 3 Barriers to
Implementation
Active only Active Inactive Reductions in
suicidal behavior &
hospitalizations (n=12)
Funding
constraints
(n=14)
Staff Turnover
(n=7)
Built DBT program
despite high
obstacles (n=7)
Staff
turnover
(n=12)
Funding cut
(n= 5)
Built
comprehensive
adherent program (n=5)
Time
constraints
(n=10)
Lack of support/
conflict with key
administrators
(n=5)
• This study integrates implementation
science and QI research in order to enhance
and personalize the customer training
experience
• Generally high rates (75%-98%) of
delivering DBT modes
• DBT programs are resilient: Only 15 %
(N=16) of the 105 teams reached reported
an inactive status
• Top barriers to implementation similar
across active and inactive programs, with
exception of inactive programs voicing lack
of administrative support/conflict
Looking Forward:
• Examine links: adherence & client
outcomes
• DBT on administration: use data to leverage
commitment, strategic planning
• DBT commitment strategies for staff prior
to attending intensive-more systematic
screening processes needed
• Additional attention needed in several
implementation domains, such as ongoing
outcome assessment, supervision &
adherence assessment, team selection and
cohesiveness
Phase 1: A random sample of 50%
of all teams (Final N=78) who
completed Dialectical Behavior
Therapy Intensive Training ™ by
Behavioral Tech, LLC from 2008-
2011
SAMPLE
Phase 2 (1 year later): Contacted
the other 50% of teams (Final
N=77) to assess implementation
obstacles for inactive programs
PHASE 1 QUANTITATIVE RESULTS
Are teams still doing DBT?
Are teams delivering the four modes of DBT?
Quality Assurance: Are programs tracking
treatment delivered?
• 40% conduct manual-based self-assessment of DBT program
adherence
• When collected, 20% of programs give individual DBT
adherence data to teams & supervisors for quality improvement
purposes
• 16% of DBT team leaders and consultants review fidelity
performance data
Yes = 74%
(N=58)
No = 10%
(N=8)
Unknown =
16% (N=12)
How many
programs hold
consultation
team? 90%
Designated
team leader? 80%
Teams meet
weekly? 74%
Identify DBT program elements currently in place amongst intensively trained
teams
Identify factors that contributed to DBT program
failures
Provide opportunity for reflection, self-assessment,
and dialog on stage of DBT implementation
Create immediate and direct feedback loop between
training needs and marketing/customer service
initiatives
Enhance Quality of Trainings and
Implementations
Strengths and Limitations in DBT Implementations: A Mid-Stream, Mixed Methods Examination of Successes and Failures
Erin Miga, PhD1,3, Andre Ivanoff, PhD2,4, Tony DuBose, PsyD2
1Cadence Child and Adolescent Therapy; 2Behavioral Tech, LLC, Seattle, WA; 3Behavioral Research & Therapy Clinics, University of Washington; 4Columbia University
References
1 Pasieczny, N., & Connor, J. (2011).The effectiveness of dialectical behaviour therapy in
routine public mental health settings: An Australian controlled trial. Behaviour Research and
Therapy, 49(1), 4–10.
2DuBose, A., Ward-Ciesielski, E., Landes, S., Korslund, K., Comtois, K., Ivanoff, A., Dimeff, L., &
Linehan, M. (August, 2011). The Dialectical Behavior Therapy Intensive Training Model ©
(ITM). Poster session presented at the First Biennial Global Implementation Conference.
Washington, D.C.
3 Landes. S., & Linehan, M..M. (2012). Dissemination and implementation of dialectical
behavior therapy: An intensive training model. In D.H. Barlow & R.K. McHugh (Eds.),
Dissemination and implementation of evidence-based psychological interventions. New York:
Oxford University Press.
4 Schmidt, H., Ivanoff, A., & Linehan, M. (2009). Program Elements of Treatment
Questionnaire. Seattle, WA. University of Washington Behavioral Research & Therapy
Clinics.
5Knox, S. & Dimeff, L. (2001). Barriers to Implementation. Behavioral Tech, LLC.